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Clinical challenge
Volume 52, Issue 8, August 2023

August 2023 clinical challenge


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How to use AJGP for your CPD
Each issue of the Australian Journal of General Practice (AJGP) has a focus on a specific clinical or health topic. Many GPs find the entire issue of interest and of relevance to their practice; some GPs find one or more articles in the journal relevant.

You can use AJGP for your CPD. If you want to use the entire issue for CPD, you must work your way carefully through each article in the issue and complete the Clinical challenge. When you do this, take time to read the articles carefully and critically, and think carefully about how you might adjust your practice in response to what you have learned.

We recommend that you access AJGP, the articles and the Clinical challenge through gplearning (Activity ID: 529382). Then, when you complete the articles and the Clinical challenge, your CPD hours are automatically credited to your CPD account. If you work through the full issue of AJGP and complete the Clinical challenge, you will receive 10 CPD hours (five hours’ Educational Activities and five hours’ Reviewing Performance).

If you do not want to do the full AJGP issue, and you prefer to select one or more articles to read, you can QuickLog the CPD hours directly through your myCPD dashboard. As guidance, each article in AJGP would provide 1–2 CPD hours, split half Educational Activity and half Reviewing Performance.


These questions are based on the Focus articles in this issue. Please choose the single best answer for each question.

Case 1

Emma presents for review with her son, Ben, aged three years, who she believes may be a gifted child.

Question 1

‘Giftedness’ in children relates to high potential, whereas ‘talent’ relates to high:

  1. grades
  2. achievement
  3. capacity
  4. ability
Question 2

When a gifted child shows a large disparity between intellectual, emotional and psychomotor abilities, this is referred to as:

  1. defiance
  2. autism
  3. asynchrony
  4. tantrums

Case 2

Uncle Malcolm, an Aboriginal elder, aged 66 years, presents with his son, Keith, due to concern for gradual decline in cognitive ability.

Question 3

The Good Spirit, Good Life tool is a co-designed and culturally validated quality-of-life tool that can be utilised to optimise:

  1. longevity
  2. contentment
  3. spirituality
  4. wellbeing
Question 4

Childhood and adolescence risk factors for dementia include trauma and early life adversity, middle ear disease, low level education and:

  1. smoking
  2. impetigo
  3. scabies
  4. trachoma

Case 3

Randhir, a male aged 83 years, requests a general practitioner (GP) assessment of his ‘fitness to drive’.

Question 5

On-road driving assessment remains the gold standard, but has limited:

  1. options
  2. routes
  3. applicability
  4. accessibility
Question 6

Austroads guidance is based on scientific evidence; however, due to its limitations, it requires:

  1. GP clinical judgement
  2. driving assessments
  3. physical examination
  4. sensory assessment

Case 4

Margarita, a female aged care resident aged 84 years, with background of dementia presents with progressive word-finding difficulties.

Question 7

A common cause of early onset dementia (onset before the age of 65 years) is:

  1. vascular dementia
  2. neurosyphilis
  3. frontotemporal dementia
  4. Parkinson’s disease dementia
Question 8

The most common form of dementia is:

  1. vascular dementia
  2. Lewy body dementia
  3. frontotemporal dementia
  4. Alzheimer’s disease
Question 9

Dementia with Lewy bodies is an alpha‑synucleinopathy and is associated with neuronal loss in the:

  1. cerebellum
  2. substantia nigra
  3. amygdala
  4. hippocampus
Question 10

The typical clinical manifestation of Alzheimer’s disease in the early stage of the disease is impairment in:

  1. rapid eye movement
  2. coherent communication
  3. swallowing ability
  4. episodic memory

These questions are based on the Focus articles in this issue. Please write a concise and focused response to each question.

Case 1

Emma presents for review with her son, Ben, aged three years, who she believes may be a gifted child.

Question 1

Define what is meant by the term ‘twice exceptional children’.

Question 2

List six infancy signs that might indicate a ‘gifted child’.

Case 2

Uncle Malcolm, an Aboriginal elder, aged 66 years, presents with his son, Keith, due to concern for gradual decline in cognitive ability.

Question 3

List five early life protective factors for dementia.

Question 4

List 10 later-life risk factors for dementia.

Case 3

Randhir, a male aged 83 years, requests a general practitioner (GP) assessment of his ‘fitness to drive’.

Question 5

List four barriers to GP discussion of driving cessation.

Case 4

Margarita, a female aged care resident aged 84 years, with background of dementia presents with progressive word-finding difficulties.

Question 6

List two techniques that have enabled in vivo measurement of levels of Aβ plaques and neurofibrillary tangles.

Question 7

State the pathologic hallmarks of Alzheimer’s disease (AD).

Question 8

List the four core clinical features of Diffuse Lewy Body (DLB) dementia.

Question 9

List two common neuropathological findings in vascular dementia.

Question 10

State the difference in classification of Diffuse Lewy Body (DLB) versus Parkinson’s disease dementia (PDD).


July 2023 Multiple choice question answers

Answer 1: B

Two generalist skills that assist effective collaborative deliberation include owning yourself and capable engagement.

Answer 2: A

For the clinician, calm sense making involves clinical wisdom (phronesis), the discipline of tolerating uncertainty and avoiding premature categorisation.

Answer 3: C

Barriers to the access of healthcare services for men may include attitudes towards health and health services utilisation, a lack of ‘male-friendly’ healthcare settings and concepts of masculinity.

Answer 4: C

The leading cause for mortality in men is heart disease.

Answer 5: C

An AI approach, known as deep learning, has demonstrated success in detection and classification.

Answer 6: A

In improving clinical practice, AI may be hampered by the risk of replicating biases.

Answer 7: D

Decolonisation in education settings seeks to critique practice through counteracting stereotypes.

Answer 8: B

Supervisor relationship can influence attitudes and beliefs, and promote decolonised approaches through role modelling.

Answer 9: B

Research studies demonstrate that if women have negative experiences when accessing mental health services, this can affect the likelihood of disclosing distress.

Answer 10: D

Mainstream mental health screening tools are not helpful for some women due to a deductive approach that reduces opportunities for active listening.


July 2023 Short answer question answers

Answer 1

‘Generalism,’ is defined as ‘expertise in whole-person care’, and integrates biological and biographical knowledge and offers person-centred care, as well as continuity of care.

Answer 2

The four priorities of the craft of generalism include whole-person scope, relational process, healing orientation and integrative wisdom.

Answer 3

Five practical skills associated with the priorities of the craft of generalism include broad awareness, respectful connection, capable engagement, calm sense-making and owning yourself.

Answer 4

Four reasons for engaging men in sexual and reproductive health are:

  • prevention of sexually transmissible infections
  • promoting healthy relationships and behaviours
  • treatment of male sexual dysfunction
  • optimising fertility and improving the chances of a healthy pregnancy and child
Answer 5

Algorithmic bias occurs when the outputs of an algorithm benefit or disadvantage certain individuals or groups more than others without a justified reason for such unequal impacts.

Answer 6

Clinician bias refers to a set of cognitive tendencies of clinicians to make decisions based on incomplete information or subjective factors, or out of force-of-habit.

Answer 7

Availability bias refers to making decisions based on what is immediately familiar to the clinician.

Answer 8

Two approaches that supervisors could employ to promote culturally safe practice are:

  • providing education to trainees and patients through role modelling
  • delivering specific teaching sessions on self-reflection and attitudes, implicit bias and the impact of racism on patient care
Answer 9

Two barriers that reduce the likelihood that practitioners will explore the links between trauma and mental health are:

  • lack confidence in asking about and responding to trauma
  • lack of specialised training
Answer 10

Feminist perspectives on mental health aim to conceptualise mental distress in ways that incorporate the social contexts of women’s lives rather than adopting a gender-neutral, universalistic paradigm of mental health.

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